Dental therapy expands access to care, would aid most Arizonans

In a recent guest commentary in the Arizona Capitol Times, “Don’t follow Minnesota’s failed dental therapist experiment,” Robert Roda, president of the Arizona Dental Association, dismissed allowing dentists to hire dental therapists to help expand access to care in the Grand Canyon state.

Dental therapists — providers similar to nurse practitioners on a medical team — give routine care such as filling cavities and placing temporary crowns to patients in parts of Alaska, Minnesota, Oregon, and Washington. They will soon be providing care in Maine and Vermont, just as they have in more than 50 countries for almost 100 years.

John Grant

Nearly two-thirds of Arizona’s population — 4.6 million people — live in dental shortage areas. Every county in the state is designated by the U.S. Health Resources and Services Administration — either in part or in its entirety — as a “dental desert.”

Dental therapists working in mobile clinics or satellite offices could do much to provide routine treatment to rural patients and others who live in these dental deserts. But instead, a representative of the dental association refers to dental therapy as “an experiment.”

Since Dr. Roda’s commentary focused on Minnesota, it’s worth noting that the number of patients receiving care from dental therapists in that state is growing. In 2016 alone, dental therapists in Minnesota provided care in an estimated 94,392 patient visits, and they are now distributed throughout the state’s rural and urban areas in proportion to the distribution of the population at large.

Dental therapists are in great demand in Minnesota by private practice dentists, community health centers, and other dental practices. They’re expanding access for underserved populations in the state, where they’re more likely to work in community-based or nonprofit settings or clinics than are other dental professionals. And because dental therapists make a substantially lower salary than dentists, Minnesota dentists who participate in Medicaid can stretch their reimbursement rates further by employing dental therapists.

In addition to the mounting evidence of how well the use of dental therapists is working in Minnesota, more than 1,000 studies and assessments show that dental therapy provides safe and effective care.

In fact, after seeing the impact and benefits dental therapists have created in Minnesota since the program began in 2011, the Minnesota Dental Association no longer opposes the use of dental therapists in the state.

At The Pew Charitable Trusts, we base our policy recommendations on facts and data. Our analysis is rigorous. And we support dental therapy because the evidence is clear – it expands access to dental care.

— John Grant is director of the dental campaign for The Pew Charitable Trusts.

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The views expressed in guest commentaries are those of the author and are not the views of the Arizona Capitol Times.

3 comments

Mr. Grant: Why don’t you go into debt $400K to $500K to become a dentist, move to “rural” Arizona, buy a practice, and then see how competitive the market really is for those of us who are actually put our fingers in real people’s mouths on a daily basis?

Those of us out here in the trenches would love to see you nobly help your fellow man in all the mental toxicity and muck we experience in our daily lives. It is truly hard to see how dental therapists are going solve much of anything.

You said “They will soon be providing care in Maine and Vermont, just as they have in more than 50 countries for almost 100 years.” However, the Pew Charitable Trusts, does not base their policy recommendations on facts and data that are found in “A review of the global literature on dental therapists” (2013 Nash & Friedman et al). The facts show nearly all dental therapists in that literature were trained and employed by public health departments who deployed them to provide preventative and basic restorative care to school-age children in public-funded, school-based clinics. The Pew Charitable trusts is promoting dental therapists in Arizona based on nothing that resembles that model…in fact, the Arizona bill for dental therapists has no provisions at all to address the Access to Care issues of provider maldistribution, socioeconomic disparities, failure to attract and retain providers in the Medicaid system, and addresses no vulnerable populations or shortage areas. The model supported by Pew in Arizona has never succeeded in effectively or efficiently addressing the problems in any country on the planet.

Mr Grant,
I made some statements in my previous comment.
Please refute my claim that the dental therapist model supported by Pew in Arizona has never succeeded in effectively or efficiently addressing the overall dental health problems of any country on the planet.

I challenge you to provide evidence that any of the 50 countries that have had dental therapists for almost 100 years is able to show that their country has substantially conquered the issues of provider maldistribution, socioeconomic disparities, failure to attract and retain providers in their version of our Medicaid system, and that they have a free-market, private practice model that, at no cost to taxpayers, addresses the needs of their vulnerable populations and eliminated shortage areas.
Please prove to Arizonans that Pew Charitable Trusts bases their policy recommendations on facts and data, that your analysis is rigorous…that there is an excellent chance that the dental therapist bill before the AZ legislature is modeled after such a country, that dental therapists played a key role in the impressive dental health of that country and that passage of the Arizona bill gives an excellent chance of reproducing that country’s high rate of success. Certainly, out of 50 countries having dental therapists almost 100 years, there must be quite a few to point to…or you wouldn’t make such claims.
(I’ll give you some help. You cannot point to New Zealand, the 1st country to utilize dental therapists in the 1920’s. In 2006, the New Zealand Ministry of Health said this in his report: “Early childhood caries (ECC) is the most common chronic childhood disease in New Zealand, and the rate of ECC occurs in unequal proportions among different population groups. Higher rates of ECC are seen among Māori and Pacific children, children of higher deprivation levels, and throughout certain geographical regions.” Keep in mind New Zealand had the original dental therapy program…the DTs still work in New Zealand, but now their distribution and their mission is determined by the free-market. It appears to me, this free-market approach describes the Arizona dental therapist bill HB2355.)
(Here is some more help. You cannot point to Canada. Their dental therapist program fell apart in 2011, several years after they changed from DTs restricted to their school-based clinic program for school-age children to allowing DTs to work wherever the free-market took them. Seeing how the private sector attracted the DTs to the cities and suburbs, the training school closed, as did the school dental clinics. The result was a failure. This approach describes the Arizona dental therapist Bill HB2355.)

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